PP153
RISK FACTORS OF MORTALITY IN PATIENTS WITH REFRACTORY INTESTINAL FISTULAS: INSIGHTS FROM A FIVE-YEAR STUDY AT A SINGLE REFERRAL CENTER
T. Xie1,*, D. Yang1, T. Tao1, W. Wang1, C. Chen1, F. Chen1, P. Wang1, Y. Li1
1Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
Rationale: Refractory intestinal fistulas represent a severe subtype of intestinal fistulas, characterized by the absence of clinical improvement despite standardized specialized treatment and nutritional support. This study aimed to identify the risk factors for mortality and explore potential mediating factors in these patients.
Methods: This retrospective study analyzed data from 325 eligible patients with refractory intestinal fistulas. Logistic regression and restricted cubic spline (RCS) analyses were performed to identify risk factors for mortality, followed by mediation analysis to explore potential mediating factors.
Results: The overall 180‑day mortality rate was 12.9%. Significant between‑group differences were observed in comorbidities, fistula characteristics, life‑support interventions, and complications (all P < 0.05). Multivariate analysis identified eight independent predictors of mortality: age (OR = 1.149), APACHE II score (OR = 1.248), small intestinal fistulas (OR = 16.748), sepsis (OR = 12.680), diabetes mellitus (OR = 17.042), Crohn’s disease (OR = 28.288), CRRT (OR = 6.319), and timing of enteral nutrition initiation (OR = 0.934; all P < 0.05).RCS found that age exhibited a threshold effect at 60 years while the time to enteral nutrition presented a threshold effect at 12 days. Furthermore, mediation analysis showed that these independent risk factors partially mediated the association between small intestinal fistulas and mortality (all P < 0.05).
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Conclusion: Eight factors have been identified as independent predictors of mortality in patients with refractory intestinal fistulas. Several of these factors also served as mediators. Moreover, age younger than 60 years and time to enteral nutrition longer than 12 days may reduce the risk of mortality in patients with refractory intestinal fistulas.
Disclosure of Interest: None declared